Pregnancy Exercise Recommendations Growing More Liberal

Monday, September 22nd 2003

Exercise is no longer simply being "allowed" in normal pregnancies. Rather, more and more doctors and organizations are moving towards actively encouraging it. In fact, the Society of Obstetricians and Gynecologists of Canada (SOGC) has gone even a step further in its latest guidelines by suggesting that failure to exercise during pregnancy may be associated with some risks.

The SOGC's newly released guidelines, "Exercise in Pregnancy and the Postpartum Period," are the organization's first ever document on the subject and were developed in conjunction with the Canadian Society for Exercise Physiology (CSEP). The 2 organizations claim this is the world's first example of obstetricians and exercise physiologists collaborating on the advice that should be given to the general public. The joint effort is testament to the medical shift from restrictive to permissive when it comes to pregnancy and exercise.

"As we gain more insight and move forward we will probably become more and more liberal," says Dr. Gregory A. L. Davies, one of the principal authors and chief of maternal-fetal medicine at Queen's University in Kingston, Ontario. Dr. Davies says the Canadian guidelines give physically fit patients more freedom to maintain appropriate exercise intensity and frequency during pregnancy, but the guidelines also encourage previously inactive women to start an exercise program. "We're stressing the message that if you're not exercising, you need to start, and that message has never been said before. We point out in our guidelines that we're concerned that there is a small but growing amount of evidence that if you don't exercise in pregnancy, you're not helping yourself," he said.

In fact, the document says that "Women and their care providers should consider the risks of not participating in exercise activities during pregnancy, including loss of muscular and cardiovascular fitness, excessive maternal weight gain, higher risk of gestational diabetes or pregnancy-induced hypertension, development of varicose veins and deep vein thrombosis, a higher incidence of physical complaints such as dyspnea or low back pain, and poor psychological adjustment to the physical changes of pregnancy."

The American College of Obstetrics and Gynecology (ACOG) has similar opinions on encouraging exercise in pregnancy, although the Canadian document is more detailed and offers more specifics on the level of exercise, says Dr. Lawrence D. Devoe, Professor and Chairman of Obstetrics and Gynecology, and Director of Maternal-Fetal Medicine, at the Medical College of Georgia, Augusta. The ACOG document is also less pointed about the risks associated with inactivity.

Dr. Devoe, who is himself a marathon runner, says he has long been discouraged with the unnecessarily conservative recommendations that many physicians give their pregnant patients. "An increasing number of women are coming to pregnancy with well-established fitness routines and simply don't want to hear about these kinds of restrictions. Many of them are hooked on exercise and will actually search out a more accommodating physician, rather than stop," he says.

The SOGC/CSEP document is evidence-based and indicates the quality of evidence assessment for each of its recommendations. Its 6 basic recommendations are the following:

All pregnant women without contraindications (listed) should be encouraged to participate in aerobic and strength-conditioning exercises;

Their goals should be to maintain a good fitness level throughout their pregnancy, without trying to reach peak fitness, or train for competition;

They should choose activities with the least risk of loss of balance or fetal trauma (suggestions given);

They should be advised that adverse outcomes are not increased with exercise;

They should be advised that pelvic floor exercises initiated immediately postpartum may reduce the risk of future urinary incontinence;

They should be advised that moderate exercise during lactation does not adversely affect breast milk.

In addition, specific suggestions are made on how to start an exercise program and how to determine target heart rate zones and exercise intensity.

Both Dr. Devoe and Dr. Davies regard the encouragement of exercise as an essential tool in combatting the growing problem of obesity. "If women see pregnancy as a time when they're supposed to be sedentary, this only makes the problem of obesity worse, and obesity is a terrible problem in pregnancy -- it makes it difficult to assess fetal health with ultrasound, and it increases their risk of cesarean section and difficult labors," said Dr. Davies.

Dr. Devoe says he believes pregnancy obesity could be even better addressed if the focus could be shifted to prepregnancy. "A major area that needs to be addressed is prepregnancy conditioning and fitness programs to enable a better state of aerobic fitness prior to conception. Since a major threat to good pregnancy outcome is posed by maternal obesity, it would be nice to see, in the future, a thoughtful publication that addresses and advocates a healthy preconception exercise program, with a goal of achieving fitness and normal body mass," he said.

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Source: Kate Johnson is a medical journalist living in Montreal, Quebec.

Disclosure: Kate Johnson has no significant financial interests to disclose

Footnote from Ideal Health:

The following supplements are all useful for pregnancy health. Use the links for more information.:

If you need help or advice, you are welcome to email our naturopathic team with your health question.

Disclaimer: The health information presented here has been written for the New Zealand health consumer. It is of a general nature and is only intended to provide a summary of the subjects covered. The information is not intended to be comprehensive or to provide medical advice to you. While all care has been taken to ensure the accuracy of the information, no responsibility or liability is accepted, and no person should act in reliance on any statement contained in the information provided. All health ailments should be treated by a qualified health professional.

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Disclaimer: The health information presented here has been written for the New Zealand health consumer. It is of a general nature and is only intended to provide a summary of the subjects covered. The information is not intended to be comprehensive or to provide medical advice to you. While all care has been taken to ensure the accuracy of the information, no responsibility or liability is accepted, and no person should act in reliance on any statement contained in the information provided. All health ailments should be treated by a qualified health professional. If you require additional information you can contact the healthy.co.nz naturopathic team on 0800 HEALTHY or email naturopath@healthy.co.nz